sustainable development 20 years on from the ... - José Eli da Veiga

50
Generally speaking, national health systems do not properly recognize specific adolescent
patterns of morbidity and mortality. Almost all the countries have implemented sexual and reproductive
health programmes for adolescents and several have adopted legislation or nationwide programmes to
provide formal and non-formal sex education in addition to other longer-standing schemes. The outcomes
of these efforts have yet to be fully realized, however.
Information services, efforts to build preventive capacities and skills, and access to sexual and
reproductive health services are still insufficient for the under-<strong>20</strong> age group and show sharp differences
by social sector. In particular, the use of contraception during first sexual intercourse is still very
uncommon despite the fact that sexual intercourse with no reproductive intention has risen sharply among
adolescents. In addition, girls who are already mothers are at high risk of a second pregnancy relatively
quickly, sometimes within less than two <strong>years</strong>. This warrants the <strong>development</strong> of protective measures to
avoid or postpone another pregnancy. Persistent and even growing inequalities in adolescent maternity
rates by area of residence (urban or rural), level of education or ethnic or racial identity are illustrative of
constraints on the exercise of rights and the lack of opportunities for adolescents in the most
disadvantaged groups.
Most of the countries in the region do not yet have legislation precisely defining reproductive
rights and universal access to sexual and reproductive health. Accordingly, explicit guarantees of those
health services do not exist, nor mechanisms for realizing entitlement and ensuring specific standards of
quality care. On the contrary, some legislations actually conspire against reproductive rights, showing that
national legal systems are not aligned with the relevant international agreements.
Section 3 discussed the situation in relation to HIV in the region. With regard to ICPD
commitments, progress has been made in access to antiretroviral therapy with exceptional achievements
in some cases, such as Brazil, and high rates of treatment access in others, such as Argentina, Chile, Costa
Rica, Cuba, Dominican Republic, Ecuador, Mexico Nicaragua, Paraguay and Uruguay (UNAIDS,
<strong>20</strong>11b). At the regional level, in August <strong>20</strong>08 in Mexico City ministers of health and education from 30
Latin America and Caribbean countries adopted the ministerial declaration “Educating to prevent”, which
seeks to reduce HIV transmission, sexually transmitted diseases and unwanted pregnancies through
comprehensive sex education. 9
6. Population structure
Many of the Latin American and Caribbean countries are in the midst of a demographic transition: the
process whereby a country moves from low population growth with high fertility and mortality levels to,
again, low population growth but now combined with low fertility and mortality levels. There is a period
during the demographic transition in which the proportion of the population at potentially productive ages
rises steadily in relation to the proportion at inactive ages. This period offers particularly favourable
conditions for <strong>development</strong> by boosting potential for saving and investment in economic growth while
lessening the pressure on the education and health budget. This is what is known as the “demographic
dividend” —a window of opportunity to accelerate <strong>development</strong>. Lower demographic dependency rates
help to lower poverty levels (Ros, <strong>20</strong>09) through their direct positive impact on well-being levels in
societies and they also reduce the pressure on ecosystems and rural resources associated with poverty.
9
See [online] http://www.censida.salud.gob.mx/descargas/pdfs/declaracion.pdf. Date of reference: December <strong>20</strong>11.